2017 2016 2015 ot 2018 other(s)

Division of Financial Operations 65 Court Street, Brooklyn, N.Y.11201

Division of Financial Operations 65 Court Street, Brooklyn, N.Y. 11201

1095C / W-2 Duplicate Request and Information Correction Form

DUPLICATE REQUEST

Please Check One: 1095C

W-2

Tax year(s)*: 2001197

220186

220175 ootther(s):

CORRECTION REQUEST

Tax year(s): 2001197

20186

220175

SSN# or EMPL ID

Address:

Last Name

First Name

Apt:

City:

State

Zip

Briefly describe error: (Required for W-2 correction only)

Contact Phone#

NOTE:

? Please verify your address. Address corrections can be updated by logging into ESS or by contacting HR Connect at

(718) 935-4000.

? W-2 forms will be mailed to the address that is in the NYC Department of Education database at the time of the duplicate or corrected W-2

request.

? Processing of request for W-2 duplicates and correction depends on the activation of the NYC W-2 System.

Employee Signature

Please complete the form and fax to the W-2 Unit at 718-935-3262.

*The W-2 unit is only able to print duplicate W-2 forms from 20179 to 1998.

For W-2 requests for 1991 through 1997 please submit to the New York City Office of Payroll Administration at whtwtpw:/./nwywc.wg1o.vn/hyctm.glo/ovp/aas/dsoewtsn/olopaad/dso/pwdnf/lwoa-2ddsu/ppdlifc/fa4t3e0.p-d0f06 w 2 duplicate request form.pdf

For 1990 and earlier, please complete the archived W-2 Request form: httttpps:://isncfohhoubo.eydc.o.grgo/dvo/cNsR/de/rfdauoltn-slyoruercse//3d8oe3-Eem6pElo8y3e-eEs-ConCly7/w-42-0aFrc2hi-v8e2dC-reAq-uCesBt-Efo3rm8-Abe7fAorEe-C198970/.p0d/0f?8sWfvrs2nD=5a4ta68Rbed3qbu_e4stFormRecordsResearch.doc This request must be submitted to the Office of Employment Records Research.

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